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What are the psychological similarities between addiction to technology and other forms of addiction? Is it possible to have a healthy relationship with technology, without cutting it totally out of your life? Kirsten Chang, segment producer at CNBC,
leads a panel on technological addiction.

Kirsten Chang
Moderator
Segment Producer
CNBC
@kaecee16

Dr. George Nitzburg
Adjunct Professor
Teachers College, Columbia University
@tech_shrink

Julia Hormes Ph.D
Assistant Professor of Psychology / Licensed Psychologist
University at Albany, SUNY
@ualbanynews

Nicole Amesbury, MS, LMHC
MS, LMHC & Head of Clinical Development
Talkspace
@nicoleamesbury

Kirsten Chang: Today’s panel, it’s basically technology, is it making us mentally ill. It’s a fascinating topic because as we all know technology pervades every aspect of our lives. Many of you who have kids or are millennials or who aren’t millennials know how hard it can be to detach from all the devices and unplug every once in awhile. Sometimes it goes far beyond that into more serious levels of addiction and so on that note let me introduce our three panelists today. First we have Dr. George Nitzburg. He earned his PhD in Clinical Psychology from Columbia University. He’s an adjunct professor at Columbia University where he teaches a Master’s level class on how technological advances can affect our well-being and the role human dynamics play in creating successful technology.

Then we have Dr. Julia Hormes. She’s a clinical and health psychologist and a director of the Health Behaviors Laboratory at the University at Albany whose research interests include the psychology of human food choice and non-substance behavioral addictions such as to online social networking and videogame use. Then finally we have Nicole Amesbury. She is the Head of Clinical Development here at Talkspace and a therapist in practice. She holds a Master’s degree in Science and Mental Health Counseling from Nova Southeastern University in Florida and she spent the last four years working with experts on best practices for alternative delivery of mental healthcare.

I guess we’ll kick it off with you, Julia. In terms of addiction, in terms of online addiction, what is addiction? How do we define it? How do we identify it? It’s obviously a lot harder to quantify when we’re talking about a digital overdose as opposed to a drug overdose or some other substance. What are the criteria or the signs that you look for?

Julia Hormes:
Sure, so in substance addictions we know that there’s certain criteria that cut cross a lot of different diagnostic categories that we look for and I think everybody’s pretty familiar with those, so tolerance, using more and more over time to get the same effect, withdrawal, getting really irritable and angry when you can’t have access to a substance. The approach that we’ve taken in looking at the addictive potential of use of some of these modern technologies that we’ve been talking about all day is pretty much the same thing.

Looking at are we seeing evidence for tolerance or people spending more and more time on these applications, withdrawal, getting really irritable if they’re somewhere where they don’t have access. Do we see cravings? Also, a level of impairment and so it’s just keeping people from engaging in other valued activities, being effective at work, fulfilling responsibilities at home. We’ve really taken that approach of translating diagnostic criteria that we typically use for substance addictions and then looking, does that apply in the domain of …

Kirsten Chang:
Right, so in terms of studying, you’ve delved deep into food addictions. What parallels do you see between food addictions and online or technological …

Julia Hormes:
Yeah, so it’s taken me awhile to really draw those parallels, but I think the biggest thing that I see is more when I started to think about treatment and interventions that we can use to help problems related to excess use of these technologies. It’s really this problem of not being able to prescribe abstinence. When it comes to alcohol addiction and cocaine addiction, even smoking, we know what the end goal is. The end goal is ideally to not use at all.

With the eating disorders which are where I originally came from in my research the challenge really is to normalize in everyday behavior. We all have to eat three, four, five times a day, how do we get people to eat in a way that isn’t pathological, but just healthy and eating for nutrition, eating for sustenance. I think the same thing is really the challenge with using social media, using email. It’s not realistic in today’s world to tell people you have to get off your phone entirely. Most of our jobs depend on being able to do that, so finding a way to normalize behavior that’s really everyday needed I think is the challenge.

Kirsten Chang:
George, from a psychological standpoint do you find … In this case are there certain individuals more prone to this kind of addiction than others whether it be … People talk about addictive personalities, people maybe with depression or some form of OCD might be more susceptible to falling into this?

George Nitzburg:
I do think that there’s certain people who may have underlying predispositions that might make them more susceptible to things like videogame overuse or social media overuse, if you’ve got tendencies towards obsessional thinking or compulsions, if you’ve got really maybe troubles with addiction in the past, things like that. You may also be prone to overusing things like social media, but I also think … I don’t necessarily know, this is an emerging field and we may see that things are more addiction-like than they are addiction necessarily. We may not see cravings or withdrawal symptoms like shaking or things like that when you get off of Facebook.

Kirsten Chang:
Right, like clear cut signs…

George Nitzburg:
If it is addiction-like in that respect there is a point in which you say are we splitting hairs because really at the end of the day if it starts impairing functioning to that level and you’ve got underlying conditions that may be driving it it really comes down to the same thing. I do think that’s interesting.

Kirsten Chang:
Definitely, and I know you’ve done some research with videogame violence in particular. I know a lot of folks out there have kids who play videogames or maybe play them themselves. How do you begin to identify whether that becomes too immersive for them?

George Nitzburg:
I think it’s necessary to look at whether it is supplanting what they would normally do otherwise, or whether it is something that’s complimenting what they do. There are many games actually when we were running the study, Grand Theft Auto III was the big game there, so it was many years ago. The big thing was that that was actually a playground phenomenon at that moment. It would have been very odd to not be engaged in that. You would have been out of the loop with your other friends. That’s very different from somebody who overuses and they start dropping out of their normal activities, so they start failing in school or doing poorly. I think that’s what you’ve got to take into account.

Kirsten Chang:
Use it as an alternate reality.

George Nitzburg:
Yeah.

Kirsten Chang:
From the actual.

George Nitzburg:
Yeah, you’re entering into a fantasy world and leaving something else.

Kirsten Chang:
Yeah, I understand. I’m a gamer myself, but I don’t play a lot of first person shooters, but I have played Grand Theft Auto. In terms of identifying the problem, Nicole, what is it about the online world of social networking that makes us feel like we constantly need to be plugged in? You’re saying it goes beyond just fear of missing out or FOMO or image envy and sometimes it becomes a much more personal time suck for certain individuals.

Nicole Amesbury:
I think so. I think one of the things that keeps us connected is because as humans we want to connect and belong. Our relationships are in many aspects the most important part of our lives. One of the things that happens, of course, online is relationships are augmented or you may even have a whole relationship online. If you disconnect from say Facebook you’re basically disconnecting from however many friends you have, maybe your grandma, and you’re not going to be able to share in the same way. Of course, this makes it very hard to pull away. Then if we feel any anxiety in our relationships we’re more likely to move towards that for reassurance and to try to figure out what’s happening here. We see this, for example, in someone who suffers a breakup and they don’t disconnect on social media. Then they’re compulsively checking and obsessing about what it is that …

Kirsten Chang:
Stalking.

Nicole Amesbury:
… their partner was doing, creeping, stalking and it’s hard to pull away and it’s hard to get over the heartbreak, so they do it as a reassurance for their anxiety and to feel connected, but then it’s a double-edged sword.

Kirsten Chang:
Right. Let’s dig a little deeper and hone in on some of the adverse effects of technology. George, coming from a clinical psychologist standpoint, in terms of you’ve got the notion of digital amnesia, which is like you have so much information at your fingertips you don’t need to remember any of it anymore. Your recall deteriorates as a result of having all this information all the time. Beyond that let’s talk about how this constant influx of stimuli affects your emotional state whether it’s digital ADD. You can be clicking on one thing, getting a suggested video and then your ad pops up for those shoes you were looking at earlier. It’s insane. On a subconscious level what adverse effects are we looking at?

George Nitzburg:
I think that there’s really an amazing effect of having this pervasive and just constant stream of especially social information coming at you because often times people who suffer from various forms of mental illness what they’ll have is they’ll have trouble with socializing, trouble processing social information, interpersonal difficulty. That will co-occur with symptoms that are happening. What’s so interesting is asking somebody to refrain from let’s say Internet surveillance, for example, or something like that. When they are someone prone to interpersonal difficulty and they have Facebook or another social media application at their fingertips it’s like asking an alcoholic to stop drinking when they’re living in a liquor store. There’s just a constant stream …

Kirsten Chang:
It’s right there in front of you.

George Nitzburg:
… of social information that can … At least if you think about it, five percent of that is taken the wrong way, so to speak, or it’s seen in the wrong context because of old patterns or things like that, it can really throw someone off.

Kirsten Chang:
Right, right. We’ve talked about the problem. How does one go about treating something like that? What’s the solution? Julia, coming from the world of eating disorders, obviously you said total abstinence just doesn’t seem possible or realistic, so what do you suggest?

Julia Hormes:
I think for the most part it’s not really realistic for us to get off our phones, so what we’re really looking at a lot in my lap is the underlying mechanisms. What are risk factors that might make some people more vulnerable to develop problems related to some of these technologies. One of the things that we really focused in on that may provide a target for treatment is what we call emotional regulation deficit, so this idea that basically all these applications, all these behaviors really serve to distract from negative emotions. We don’t like to sit with boredom or sadness or anger and so getting on Facebook, getting on Twitter is a quick way to get away from that.

I think one of the areas where interventions really are useful is to think about can we teach more adaptive ways of dealing with the negative affect, that people don’t develop this reliance on these other ways of distracting from it. Getting to the point that we talked about earlier, what are some of the negative effects of having this constant stream. Thinking about this earlier, the other panelist was talking about mental illness in relation to social media uses. I think we’ve forgotten the value of sitting with these uncomfortable emotions. Several decades ago that was a pretty normal thing to wait for the bus and just be bored for a bit.

Kirsten Chang:
Right, right.

Julia Hormes:
I think there’s value in those times where I think it leads to a lot of creative thinking and innovative thinking, not constantly being distracted and not constantly being plugged into something else. I think we’ve really taken that away from ourselves to really have those moments where we go inside and we introspect and see what’s going on. I think that …

Kirsten Chang:
We’re so easily distracted now with all the multitasking going on. George, what do you propose as a solution to this problem? Do you think identifying it involves taking it away temporarily and then seeing if you have withdrawal symptoms, so how do you go about combating that?

George Nitzburg:
That’s my recommendation is that if you are using something a lot and you’re starting to have a glimmer that maybe, I don’t know, could this be a problem. If you just take a week off and you say, okay, I’m going to take a week off of this. What happens? Is it really an impossible task? Is the reason behind that … I would agree, emotional regulation is so key, it’s the key underlying thing. Are you having trouble with regulating emotions? Are you having trouble sitting in distress all of a sudden because you took this Internet platform away or this digital tool away. Then if you reintroduce it does that cause an incredible amount of relief. That’s when you start saying to yourself I might need to get some help with this.

Kirsten Chang:
That I’m too dependent on this.

George Nitzburg:
Yeah.

Kirsten Chang:
Nicole, I know you’ve worked specifically on programs to treat social media dependency. How would you suggest dealing with this problem overall? Social media is out there constantly. The idea that you can treat the dependency on it is unfathomable.

Nicole Amesbury:
I think you really have to spend some time looking at the person, the individual, and how they’re using it. There can be many different ways to be overly dependent and if we talk about emotional regulation it actually can be beneficial in some ways to be able to express yourself online through YouTube and sharing photos and stuff when it’s done in a way that’s really pro-social. Unfortunately, it’s not a lot of times and there’s bullying and things like that.

I think you have to look at somebody’s use and why and then I think the most important thing is how can we get people to understand that we’re using the technology, the technology isn’t using us. We’re not just being funneled mindlessly through a website to click, but that any interactions we have online we recognize that they can be meaningful and really education’s a lot about that. Somebody also mentioned earlier about schools needing maybe some education on that and that’d be a good start, that’d be one place you could pick it up. Each person needs to think about their use and why.

Kirsten Chang:
Right, on the other hand technology … It’s a double-edged sword. It certainly can help us in a lot of ways. How do we use that to … What are some positive influences technology has in terms of treating maybe mental illness or any of these disorders we’re talking about?

Nicole Amesbury:
Yeah, I can answer this really well because that’s what we do at Talkspace is have relationships with people online.

Kirsten Chang:
Recognize there’s somebody on the other side of that screen.

Nicole Amesbury:
Yeah, and I think a big thing of what’s happened is we’ve created this nomenclature culture where we say a user, I’m going to block him, I’m going to friend him. We’ve changed our idea of what sharing is, what liking something is and we’re talking at people and not with them in a lot of instances. We need to figure out how we can turn that around a little bit. For example, our community of therapist talks and when we share we’re pretty mindful not to say “end user” even though we all know it’s a startup term. We can be like oh, … the end user, because there’s something that an end user that doesn’t … Somehow the therapist doesn’t sound as human, so we say person or client and we try to be very careful and mindful about that. We still sometimes … just talking fast as the user, but I think it’s important how we use our words.

Kirsten Chang:
On that note what in your opinions constitutes a healthy relationship with technology? One where you can use it effectively, not let it use you, as you said without allowing it to take over your lives? George?

George Nitzburg:
I think that really I tend to think that technology use has to be … As I said before it has to compliment your life. I often think of it as ultimately these are tools for human connection and at the end of the day that’s what we want and that’s what’s healthy is to have human connections and to be heard. Often on these platforms what we end up doing is there’s talking, there’s screaming into the void or talking to the void. There’s not a lot of being heard or if there is being heard we know that now the norms are just be overly positive …

Kirsten Chang:
Right.

George Nitzburg:
… in whatever you say. You’re only hearing one-half of the picture of someone’s life. You’re hearing what’s going on that’s very positive in their life, but not the challenges they’re undergoing. I think the goal really is to find the aspects of digital platforms that are pro-social that allow you to express yourself in a way that others are hearing you. Maybe perhaps instead of posting to the newsfeed of a social media platform to direct message where we know that people can and do post negative things as well as positive things first.

Kirsten Chang:
Right, so more of a dialogue.

George Nitzburg:
Yeah, and have a dialogue and have a human connection.

Kirsten Chang:
Right, right.

Nicole Amesbury:
I think we see this more, too, with the increase of asynchronous voice message and different ways of sharing because if you just post something on a platform you get a little emoticon or something to click that says that I heard you, but there’s a lot of other ways that people can express that they’ve heard someone.

Kirsten Chang:
Sure, and Julia?

Julia Hormes:
This has been a very eye-opening day for me because I feel I have a very bias view on these things because obviously I’m mostly focused on problems related to excess use of things like social media and so really thinking about some of the upsides to having this technology available to us. A couple of things that came to mind for me is … Again so thinking about more of my work in eating disorders. I know this was a topic of conversation at the earlier panels of exposure to all these idealized images of women and men fits aspiration, all that kind of stuff and the influence it has on mental health.

I think there’s a flip side to that, too, in that we now also have much more access to regular people posting images on their social media sites that maybe back in the day when we were all just flipping through magazines we didn’t have that access. Just like those lawyers are showing that exposure to these idealized forms really lowers satisfaction, exposure to more realistic shapes and figures of people actually has the opposite effect, so I think there can be a positive in that.

Then another aspect tying into some of the work that we’ve done, again this role of emotional regulation deficits and you mentioned the addictive personality earlier which very controversial construct. We’re getting back to this idea because what we actually see is in the people that we surveyed who report problematic use of social media they’re actually also people who report a lot of problems with the more traditional substances. They’re more likely to be problem drinkers.

It seems that the risk factors are the same, that they’re either going on Facebook to distract from depression or they’re getting a drink to distract from depression. At the same time maybe social media is a way for us to reach a population of people who perhaps are struggling with alcohol or struggling with drugs who would never come in and see a therapist, but they might be more responsive to interventions that we deliver through those platforms. I think that might be another aspect to it.

Kirsten Chang:
To spread awareness, yeah, absolutely.

Nicole Amesbury:
This is just such an interesting point because I think when you look at addiction one of the things you look at is is it a progressive problem? Does it get worse over time? Of course, that’s hard to gauge when you think about the Internet because the whole Internet and all of our online time has expanded over the years. One of the ways that we can tell when someone’s doing a little bit better when we’re caring for somebody online is that we see patterns of how much they communicate with this change over time. Sometimes it’s more when they’re in a difficult place, but overall I think in time we see them communicate with us less when they don’t need us as much. It’s interesting how we foster either dependence or interdependence with technology.

Kirsten Chang:
Yeah, absolutely. Also, I think on a basic level technologies infiltrate our lives so much that it becomes a way for us to forget how to interact with people in real life. Now we have apps to order Starbucks way ahead of time. We don’t have to talk with anybody, we don’t have to talk with a barista and people who don’t have their coffee probably don’t want to talk to people that early in the morning. I can relate. I think it’s important to just force people to just go outside and interact with people in the real world, something as simple as that could be useful for younger kids at least. Get them off the iPad.

In terms of … We live in a new age of technology where some of the old paradigms and healthcare and treatment are antiquated and outdated. They don’t apply anymore. How can technology be used effectively for therapy? How is it disrupting the space, where does it fit in, how do we integrate it into the future of therapy to bring it back to the title of this conference? Yeah, George?

George Nitzburg:
Well, when you look at the best statistics we have which is the National Comorbidity Survey, really about 30% of people at any given time have mental health conditions and are not seeking help for them. Forty percent of people … Or excuse me, I’m sorry, reverse that, 30% of people get mental health help and about 70% of people don’t. That number’s about 40% if you include the primary care physician or a pastor or someone who may or may not be trained, so this is an incredibly potentially disruptive and potentially valuable source for therapeutic help. Really the question that is how do we best find the number of sessions and things like that, the factors that make that the most effective possible.

Kirsten Chang:
It gives people more access to it who may not normally have it because I was hearing earlier waitlists can be up to three months long.

George Nitzburg:
Yeah, they can be up to three months long and that’s speaking about in the United States and it gets even more drastic when you’re talking about a second or third world country and so it’s really an issue that is pretty pervasive.

Kirsten Chang:
Yeah, and in terms of what we call telepsychiatry, telemental health, telebehavioral health, whatever you want to call it, online psychiatry. Some critics will say, okay, but you’re missing some of the valuable non-verbal mannerisms or clues that your patient is giving you based on their voice or body language. How would you respond to those critics?

George Nitzburg:
I think that there’s no doubt there’s a loss of the AV signal, but I think that there’s been an underestimation, a pretty consistent underestimation of how people are able to use whatever format of communication that they’re given with other people to form connections and to really … It’s amazing to me that on AIM and on Facebook these norms develop. People develop ways of seeing how each other interact. This is what we’ve evolved to do is to be social animals and to see all these little social cues. Even when we’re at perhaps a disadvantage or where we don’t have AV signals, audio visual signals or cues, we can still manage to find these little things in whatever platform we’re using because this is a highly evolved sense.

Kirsten Chang:
Right, right.

George Nitzburg:
At the end of the day.

Nicole Amesbury:
I was just thinking of something a client of mine said because we hear that something’s missing. Someone had written an article that questioned this about what we did and my patient happened to read it. He said, “Look … ” He couldn’t get help for a long time and he finally was about to get help. He said, “Look, if I’m crying I’m going to tell you I’m crying.” It’s not like he was trying to keep it a secret from me. He needed help and he was in pain.

I think when people can see a therapist, when they get discharged from the emergency room after getting help for mental illness and then have to wait three weeks to see a therapist and then when they finally do get to see a therapist and get the intake done they see maybe a therapist once a month. Maybe they do a psych med check once every three months. I think to say that we’re missing something, it’d be a really great therapist that is overburdened with a caseload that sees a patient once a month and they’re not missing something. The fact that online you can have consistent care and be a little bit of their in vivo experience and daily life it really doesn’t make sense to me.

Kirsten Chang:
Yeah, yeah, the pros outweigh the cons.

Julia Hormes:
I think another piece of that is as you brought in access, hopefully, you also reduce stigma. It becomes a more accessible matter of fact thing for people to have access to therapists and work with a therapist. Hopefully, some of the stigma that was brought up earlier is reduced at the same time as well.

Kirsten Chang:
What can we do in everyday life to reduce that stigma because there’s so much of it still out there in terms of just being associated with a therapist or going toward a therapist’s office or anything like that. How can we alleviate that tension?

Nicole Amesbury:
I think everybody could just be more authentic online in general, be who you are is the easiest thing to say.

Julia Hormes:
We talked a little bit about the distance from talking to somebody face to face and then putting something out on a blog or on Facebook. I think people might be more willing to talk about their struggles with mental health on a blog than they are face to face with friends and putting it out there and showing people that this is something that is affecting quite a few of us. I think there’s an advantage to that and having a forum for doing that maybe more openly and more willingly.

Kirsten Chang: Right, right.

 

George Nitzburg:
I think there is an aspect of this that really is about the limitations of discretion for physical therapy that we haven’t seen until there’s been these other options. In a small, rural community you’re not really going to see the therapist, you’re going to see Bob and Bob lives across the street from Susan. If you go into Bob’s office Susan sees you and it’s a small town and rumors spread quickly, et cetera. I think there’s the discretion available in accessing a platform that’s online, it does have that benefit.

Kirsten Chang:
Right, right. We still have a little bit of time left before Q&A, but we can open up to it early. If any of the audience members has questions for the panelists here. Yes? Do we have a microphone somewhere?

Audience Member 1:
… Can you just talk a little bit about online dating, how that impacts the mentally ill … There’s a lot of folks who I’ve worked with that are on maybe 15 different online dating sites…

George Nitzburg:<br/ For the people who don’t have a mic who are streaming this is a question about online dating and how that might make us ill. I can certainly speak to that. The online dating is really about selective self-presentation is the research term that’s used for it, meaning taking the best possible picture and accentuating the best possible qualities of yourself. It’s not unlike what’s happening in the norms on social media to only post the positive information.

It is in some ways remarkable that people do accentuate all their positive features and take these photos when … Not a week later do they meet the person on a date and so what the research has shown is that contrary to what you might expect not only are they hurt that the other person might bring it up, but they’re very angry that the other person did that as well because they’re both doing it. It’s this really ironic thing that I think can contribute to this sense of poor self-worth, poor body image in some cases. It’s definitely social comparison where you feel other people are living happier, better lives than you are or who look better, feel better than you do, but it’s all this best foot forward.

Kirsten Chang:
Right.

Nicole Amesbury:
As much as I’d like to believe all the Tinder and Match.com and all the sites want people to fall in love with one person and stay in love and have a great, intimate relationship forever. I happen to think they probably want to make money, too. I think looking at the design of those type of sites is something that would … For people to be more savvy consumers of those sites would be good because even though you start talking to one person you may be approached by way more than you would if you were not on a site. It gives you this idea of choices, that you have much more choice maybe than you actually do. I see a lot of people trapped in the choice process of do I stay or go because maybe I could do better over here or maybe this or that. They’re just inundated with having to make a choice when they go onto one of these …

Kirsten Chang:
Right, decision fatigue.

Nicole Amesbury:
… do I slide, slide, slide. What do I do? I think looking at the funnel and design as a savvy consumer is a good idea.

Julia Hormes:
The online dating is I think a fascinating area because it’s so prevalent and yet we have so little data on it. We always included some questions on online dating in our surveys and something we notice is we actually ask people about their motives for being on these applications. A very large number of our respondents, primarily undergraduate students, said that they are on these dating sites with no intention of finding a relationship. What we’re looking at is really again are these applications surveying just the purpose of having something to do as you’re waiting for the bus or a particularly boring class and you’re swiping left, swiping right.

Kirsten Chang:
Yeah, it’s like a game.

Julia Hormes:
It’s just another one of those things and something we talked about earlier and hasn’t come up yet, this thought about how do these problematic behaviors actually develop over time. I think there the analogy that’s most useful to me in thinking about it is the gambling where what keeps people coming back and placing bets is the next time it might pay off. With a lot of these applications the next time you go on somebody else may have looked at your profile or somebody may have liked something or somebody may have looked at something and left a comment. I think that’s really ultimately a lot of times what has people coming back and not necessarily the intention of I’m going to find the love of my life.

Kirsten Chang:
Right.

Nicole Amesbury:
It’s concerning because the CDC did research, too, on rates of sexually transmitted diseases and things like this and app use and correlated them. They do find that in places where certain platforms are used more they do have an increase in sexually transmitted diseases and infections.

Kirsten Chang:
Wow. Yes, this gentlemen right here.

Audience Member 2:
Hi, Steve Bisson. I’m a Talkspace therapist. I like the idea of pro-social use of social media, but I didn’t hear a lot of examples in how we can use it. I was wondering if anybody had good examples that they can share.

George Nitzburg:
Sure, I can speak to … I know that in videogames … There are many videogames that they don’t get a lot of public attention that are … There’s a whole new field developing of serious games and games that are out to solve pro-social issues. Even moving beyond the serious games movement that’s trying to take game mechanics and put them towards social good there are games that are non-violent and that promote a multiplayer … What you’d think of in child development terms as parallel play. That you engage in a shared activity, but you’re not directly interacting with each other.

These are perfectly reasonable forms of connection for people and there’s ways in which we are creating a more connected world where … In the past if you left high school, if you left college, that was it for those friends. You did not keep in touch with those people and now you can maintain connections across long distances. There’s lots of social ways to do that and you can do it even around a shared interest especially, for example, a game that’s online or things like that. Then there’s these other negative possibilities which, of course, receive the most attention because we want to find solutions for them.

Nicole Amesbury:
I think if everybody took a little bit of time when they see something that a friend of theirs shared and thought about a way to deepen the conversation or write a thoughtful response instead of just clicking like and going on a date. If you took a little bit of more quality time to respond to people thoughtfully really it’s a simple solution. If we weren’t maybe bombarded with … It’s the amount of information, too, because I think what pulls us just to click like and move onto the next one is because it’s so much … If you scroll through Instagram, for instance, it’s like photo after photo after photo.

Kirsten Chang:
Yeah, you’re inundated.

Nicole Amesbury:
Nobody really stops to take the time to say something really thoughtful.

Kirsten Chang:
Yeah, I agree. That’s why these new interactions like like and ha-ha on Facebook I feel they’re a bit superficial and I don’t think they add anything to the conversation, but anyway. Any other questions from the audience?

Audience Member 3:
Hello, Howard again.

Kirsten Chang:
How are you?

Audience Member 3:
This time standing up. The videogame question, I have a big interest in that just because I play videogames, my kids play videogames and thinking about the sandbox style of videogames where you got a bunch of players from different servers all in the same virtual room if you will. That’s a great place for bullying to happen and for people to try out whatever they would typically use like keyboard courage, just say nasty things to someone, just being a provocative bully. Like oh, I’ll say something nasty and if you bully me I’m the victim.

What do you think is the social responsibility of the videogame community or videogame developers or console or the people who manage those things to make sure that kids aren’t practicing that because they have essentially unrestricted access to buy these mature games. I don’t even know … They put the ratings on there and I don’t even know if it matters anymore because they can just buy it. I’ve had to sit next to my now 12-year-old and coach him on how to cooperate with other people because he was being nasty, I’ll just say that. I had to coach him about that, but I don’t know if all parents are going to sit there next to their kid as they’re walking through a game to do that. I just wanted to know what is the bigger responsibility to make sure that kids aren’t practicing cyberbullying?

George Nitzburg:
I think that cyberbullying doesn’t just have to take place in a context of … I would just say that it doesn’t have to take place in a context necessarily of videogaming. It takes place in a lot of different social media contexts. That being said I do see what you’re saying, whenever you’re playing a game it can become monkey in the middle or it can become an exclusionary way to exclude or bully. I do think that the way that you design any of these tools … In my view there are all sorts of games and tools that can facilitate that or it can really prohibit it. There needs to be a psychological mindedness to the design of these products.

It’s part of why I research what I research and I teach about what I teach about because I think that it is really interesting that there is not more psychologically minded or psychological consultation when implementing the design and the user interfaces of products in general. Of course, products that deliver therapy services are obviously not psychologically minded in their mission in general. There are many websites and things like that that I think could … They are made so that they draw you in.

I think a small piece of this behavioral addiction that we’ve been talking about is that user interfaces are designed with the inherent goal of keeping you coming back. They’re going to be designed not as … I’m not saying they’re slot machines in any way, they’re not like that level, but they have elements where they want you to click again, they want you to refresh. Facebook is a prime example where actually you have a fixed ratio reinforcement schedule and a variable ratio reinforcement schedule. You click and you get something, but you don’t know what it is. It could be social information that’s good, bad, et cetera. It can be quite habit-forming is what I would say.

Julia Hormes:
I think you mentioned the answer as part of your question which is the importance of appropriate model and I think that’s really the danger of spending so much time on these applications, especially now with generations unlike me don’t remember a time when there wasn’t Facebook and there weren’t cell phones and there wasn’t text messaging. I think that’s partly the concern of spending so much time on these applications is it’s at the expense of face to face or human interaction which gives you that feedback of oh, you can actually talk to people like this and expect them to be okay with it. I think that’s really the importance of the balance and still having that face to face contact which comes with feedback on how people actually respond to the things that you’re saying which you don’t necessarily get online.

Nicole Amesbury:
I think everybody needs to take some responsibility just a little bit. We’re all in it together. There’s end users you can say, there’s developers. We’re all using this and we can’t say, okay, one person has to do this, but then the parents don’t have to watch the kids. Everybody needs to take some responsibility and the technology has moved faster than I think we’ve really thought about it.

Kirsten Chang:
This gentlemen back here.

Audience Member 4:
I think I agree with Nicole. As a parent I had to realize that I think the problem comes from parents and not from kids. If from a very early age you are teaching your kids how to behave in the courtyard or how to ride a bicycle because you’ve done that before then the problem wouldn’t be here. When they’re 10 years old and suddenly you put a phone in their hands and you don’t tell them how to use it because you didn’t know how to use it, you never used Snapchat or Instagram before. If you don’t train them then they won’t know and you’re just like throwing them out there as putting them on a bicycle on the motorway and go ride and they might kill themselves. As a parent I think we need to take responsibility for actually playing those games and using Snapchat even if you don’t like it, but at least you have the curiosity of using it.

Nicole Amesbury:
It’d be great if there was a tutorial for parents like what is Snapchat because you go on the iTunes and you look and you see what it’s about a little bit, but it doesn’t give you the full picture sometimes. It’d be nice, it could be a whole series if somebody wants to do that.

George Nitzburg:
Certainly I have sympathy for parents who don’t … These new tools come out, these new frameworks come out and they don’t necessarily know even what they are and they just know this weird new name is popping up on your children’s vocabulary. Yes, it can be very helpful if you model how to properly use…

Kirsten Chang:
Or just go and familiarize yourself with the privacy settings, too, on things like Instagram. You don’t want tons of strangers liking your children’s pictures necessarily. Yes, this gentlemen here. Do you have a microphone?

Audience Member 5:
Hello, I’m a student in clinical psychology, a graduate student. This question is for Miss Amesbury in regards to Talkspace. Say we see the advent of digital dependencies within this digital generation and given that Talkspace is a digital medium for therapy is that going to be counterproductive in any way? How do you go about treating virtual or digital dependency?

Nicole Amesbury:
That’s a really great question. I think people have heard the expression sometimes you have to fight the devil with the demon or something like that. You think isn’t this what you are. No, one of the huge tenets in therapy is you have to meet the client where they are. We’re not able to do that in so many instances around the world because there just isn’t access to healthcare. That’s one layer of it. Another layer is is people are going to reach out however is most natural and comfortable for them. There’s a lot of people that would never reach out otherwise for a variety of reasons, some of them even very practical like they don’t have transportation.

We have to think about if we do meet people where they are in this and they do have some kind of a dependency problem what do we do with it. I’m going to say the secret is in the sauce, the secret’s in the therapy. We don’t interact with people online as if it was Facebook. The therapists are trained, of course, and so the interactions we have and how we’ve designed the site and how it’s approached is different.

It actually is a good modeling of how to be online in a way that helps people. It can often show people, wow, I can text somebody and get a completely different response than I would have ever expected in the other platform and understanding one, a compassionate one. Once people see that they can have this type of relationship online they could have that type of relationship online with anyone. It’s a really cool way to do it actually. Does that answer your question?

Audience Member 5:
Yeah.

Nicole Amesbury:
Cool.

Kirsten Chang:
All right, we’ll leave it there. Thanks so much to our three panelists. It was a great conversation for joining us today and thank you all for coming.